You have accessJournal of UrologyProstate Cancer: Detection & Screening V (MP36)1 Apr 2019MP36-17 DEFINING BIOCHEMICAL RECURRENCE IN PROSTATE CANCER WITH HYBRID PSMA PET MRI Paria Saadat, Georges Mehawed*, Michelle Ong, Andre Joshi, Matthew Roberts, Marlon Perera, Handoo Rhee, Yeates Alexander, Ian McKenzie, Janelle Munns, Greg Malone, Eric Chung, Peter Heathcote, John Preston, Lawson Malcolm, Simon Wood, David Pryor, Margot Lehman, Gustafson Sonja, Kenneth Miles, Stanley Ngai, and Ian Vela Paria SaadatParia Saadat More articles by this author , Georges Mehawed*Georges Mehawed* More articles by this author , Michelle OngMichelle Ong More articles by this author , Andre JoshiAndre Joshi More articles by this author , Matthew RobertsMatthew Roberts More articles by this author , Marlon PereraMarlon Perera More articles by this author , Handoo RheeHandoo Rhee More articles by this author , Yeates AlexanderYeates Alexander More articles by this author , Ian McKenzieIan McKenzie More articles by this author , Janelle MunnsJanelle Munns More articles by this author , Greg MaloneGreg Malone More articles by this author , Eric ChungEric Chung More articles by this author , Peter HeathcotePeter Heathcote More articles by this author , John PrestonJohn Preston More articles by this author , Lawson MalcolmLawson Malcolm More articles by this author , Simon WoodSimon Wood More articles by this author , David PryorDavid Pryor More articles by this author , Margot LehmanMargot Lehman More articles by this author , Gustafson SonjaGustafson Sonja More articles by this author , Kenneth MilesKenneth Miles More articles by this author , Stanley NgaiStanley Ngai More articles by this author , and Ian VelaIan Vela More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556027.16655.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Biochemical recurrence (BCR) can occur in in up to 50% or more of men with high risk prostate cancer previously treated with surgery of curative intent. Detection of locally recurrent or metastatic disease in the presence of BCR after treatment of localised disease at low prostate specific antigen (PSA) may be improved by use of hybrid Prostate Specific Membrane Antigen (PSMA), Positron Emission Tomography (PET) with magnetic resonance imaging (MRI). The clinical utility of this approach has been minimally reported. We sought to report on a large series of hybrid PSMA PET MRI in defining BCR. METHODS: Following Institutional Research Board approval, a retrospective review of all PSMA PET MRI studies between April 2015 and April 2017 within a tertiary referral institution was conducted. Clinical variables, including patient demographics, PSA, previous treatment and histology prior to scan, indication for scan, imaging results, and outcome post imaging were collected prior to statistical analysis. RESULTS: A total of 300 PSMA PET MRI scans were performed, of which 135 were to investigate BCR. Sixty-four patients had undergone radical prostatectomy with a median PSA of 0.43 ng/ml (Interquartile Range (IQR) = 0.21 - 1.35), in whom 15 received postoperative external beam radiation therapy (EBRT) while 71 patients had received EBRT alone. From the surgical cohort, 31 patients (48.5%) had a positive scan (median PSA level 1.3 ng/ml, IQR = 0.26 – 4; Gleason score 4 + 4 in 17 patients) involving the prostatic bed (n = 6), lymph nodes (n = 18), bone (n = 6), and soft tissue (n = 11), for median serum PSAs of 1.8, 1.35, 1.6 and 0.4 ng/mL, respectively. Median PSA for those with a negative scan was 0.28 ng/mL (IQR = 0.17 – 0.57), despite 10 patients (30%) with a Gleason score 4 + 4. CONCLUSIONS: PSMA PET MRI imaging may play an important role in detecting recurrent disease in men with BCR post radical prostatectomy. The average PSA for detection of metastatic lesions are substantially less than previously quoted figures using the standard of care imaging in the setting of biochemical recurrence. Source of Funding: None. South Brisbane, Australia; Brisbane, Australia© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e520-e521 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Paria Saadat More articles by this author Georges Mehawed* More articles by this author Michelle Ong More articles by this author Andre Joshi More articles by this author Matthew Roberts More articles by this author Marlon Perera More articles by this author Handoo Rhee More articles by this author Yeates Alexander More articles by this author Ian McKenzie More articles by this author Janelle Munns More articles by this author Greg Malone More articles by this author Eric Chung More articles by this author Peter Heathcote More articles by this author John Preston More articles by this author Lawson Malcolm More articles by this author Simon Wood More articles by this author David Pryor More articles by this author Margot Lehman More articles by this author Gustafson Sonja More articles by this author Kenneth Miles More articles by this author Stanley Ngai More articles by this author Ian Vela More articles by this author Expand All Advertisement PDF downloadLoading ...
Introduction and Objectives: Renal cell carcinoma (RCC) accounts for 2–3% of all cancers. With increasing use of Computer Tomography, a large proportion are detected earlier and amenable to focal therapies such as Radiofrequency Ablation (RFA). Our institution is unable to offer image‐guided percutaneous ablation (PA) through the public service due to lack of Interventional Radiology (IR) resources. Currently, patients with a small renal mass (SRM) are either actively observed, undergo radical nephrectomy (RN), partial nephrectomy (PN) or referred to another tertiary institution for focal therapy. Recent studies have demonstrated no difference in long‐term efficacy between RN, PN and PA treatment of SRMs in selected patients; but with significantly higher rates of morbidity in the surgical treatment groups. Our Urology Multidisciplinary Team (MDT) is supported by an interventional radiologist with Uroradiology specialisation who provides PA for our patients through a private facility and we assessed the cost‐effectiveness of our institution outsourcing PA . The aim of the study was to compare the costs associated with performing nephrectomies (RN, PN) in a public hospital with the costs of performing minimally invasive PA in a private hospital; and to assess the financial impact on the public system of the different treatment options for SRMs. Methods: The cost of performing PA at a large tertiary private hospital for patients with a SRM (<4 cm) between October 2017‐October 2018 was calculated and compared to the cost of RN or PN for patients with a SRM between January 2015 to June 2018 at a tertiary public hospital. Results: Twelve patients underwent PA (radiofrequency ablation or microwave ablation); 10 were performed under conscious sedation. A total of 56 RN and PN were performed during the studied period, including 19 patients with a SRM (RN = 15; PN = 4 with the majority (n = 17) performed laparoscopically. Mean size of lesions was similar (surgery = 29.8 mm; RFA = 27.2 mm). The average procedural time was significantly longer with surgery (219.66 min vs 54.75 min). Length of stay was longer with surgery. Cost per admission for surgery was $19 302.66 which was higher than PA costs of $4513 at a private institution. The cost of performing equivalent PA in a public hospital was calculated to be $2784.35, however this would not include staffing costs (doctors, nurses, radiographers etc).Outsourcing of PA was associated with additional Urology and Radiology appointments, MDT meetings, travel for patients and logistical challenges for the treating teams. Conclusion: The cost of outsourcing focal treatment of SRMs with PA to a private hospital appears to be similar to the same service provided in a public hospital. PA is more cost‐effective than surgery in carefully selected patients. The additional benefits of providing PA in a public hospital would include more streamlined management and continuity of care for patients. Greater funding for interventional radiology services to provide PA procedures in public hospitals should be considered by health authorities to improve access to less‐invasive treatments for SRMs and result in considerable cost‐savings for health budgets.
